Inspection on 17/01/08 for Sandringham Care Home with Nursing

This inspection was carried out on 17th January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sandringham Care Home with... 08/08/07

Sandringham Care Home with... 19/07/06

Sandringham Care Home with... 26/02/06

Sandringham Care Home with... 10/08/05

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Sandringham Care Home with Nursing Escomb Road Bishop Auckland Co Durham DL14 6HT Lead Inspector Bridgit Stockton Key Unannounced Inspection 17th January 2008 11:41 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sandringham Care Home with Nursing Address Escomb Road Bishop Auckland Co Durham DL14 6HT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01388 660966 01388 660967 pkilburn@ladhar.co.uk Ladhar Group Homes vacant Care Home 90 Category(ies) of Dementia (31), Dementia - over 65 years of age registration, with number (35), Old age, not falling within any other of places category (24) Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate named individuals as set out in the letters to the registered person dated 14 June, 29 July & 8 August 2005 which establishes the basis on which the individuals` needs will be met by the home. Where necessary the homes statement of purpose shall reflect any changes in service provision required for this arrangement. This condition may not apply to anyone else, other than the named individuals who fall outside the registered category. Named Individual : The home may accommodate a named individual as set out in a letter to the registered person dated 7 August 2006 which establishes the basis on which the individual’s needs will be met by the home. Where necessary the home’s statement of purpose shall reflect any changes in service provision required for this arrangement. This condition may not apply to anyone else, other than the named individual, who falls outside the registered category. 8th August 2007 2. Date of last inspection Brief Description of the Service: Sandringham Care home is a care home with Nursing including Dementia opened in May 2005 and provides accommodation for 90 older persons. The building is purpose built and provides accommodation on three floors. The home is located near to the general hospital and town centre. The home provides safe accessible outdoor areas with seating for service users to enjoy. The current range of fees is from £364.50 to £576.00. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is, 1 star. This means the people who use this service experience adequate, quality outcomes. Three inspectors visited the home to carry out an unannounced inspection. Currently the home is working closely with the Primary Care Trust, Durham Social Services and The Commission for Social Care Inspection to improve outcomes for people who live at the home. The purpose of this inspection was to assess the quality of the care and support received by the people and monitor any progress that has been made. The methods we used to gather information included a visit to the home, conversations with the people who live there, their relatives, healthcare professionals and the staff. We looked in detail at the care and records of people, examined other records and looked around the home. One inspector did a special observation in the dementia unit, and some of her findings are included in the report. We spent six hours at the home. We also asked staff, relatives and people who use the service to complete survey forms. These questionnaires provide valuable information to help us form a judgement about the quality of service offered at the home. What the service does well: The people we spoke to said they are happy with the care and support they receive. One person said ‘I am very happy living here, the staff are friendly, we all get on, it’s nice and clean and I am well fed’. Another said that the staff are ‘lovely and very hard working’. Relatives of the people who live at Sandringham Care Home said they were happy with the standard of care their relatives were receiving. One person commented ‘my mother has been in care for over two years and I am more than satisfied with the care she receives. She is always clean and tidy, appears to be well fed and usually quite happy’. The pre-admission assessments are thorough and the majority of people commented that they had sufficient information about the home before choosing to live there. The people who live at the home and their relatives confirmed that they know how to raise a concern or make a complaint, if they needed to. One person said ‘I would tell the staff if I am unhappy, they would put things right for me, I am sure’. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 6 Most people looked very well cared for, the atmosphere was relaxed and calm. There was a good relationship between staff and people living at the home. People said they enjoyed the food they were given and said that there was a good choice. One person said ‘the meals are good we get a nice meal on an evening. ’ What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 & 6 People who use the service experience good quality outcomes in this area. People’s needs are properly assessed prior to admission to the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The care plans we looked at showed that comprehensive pre-admission assessments had been carried out before offering someone a place. This is to make sure that the home can meet the person’s needs. A senior member of staff visits the person at home or in hospital to discuss their care needs. Social Services assessments are also used to determine this as well; these were also available to look at. People are welcome to visit the home before reaching a decision. We spoke with some people who said that they had been visited in hospital by the manager of the home. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate In most cases people’s health and care needs are being met, however there was poor practice surrounding how medication is managed, and people’s privacy and dignity was not always protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at care plans in detail, to make sure that people’s health and personal care needs are being met in the way the person prefers and to help them maintain their health and well-being. Generally they were well written and up to date. Risk assessments were in place and these had been reviewed and updated when people’s requirements had changed. The unit manager’s are currently updating and reviewing all the care plans. In some care plans problems had been identified in the daily record, but there was no further detail on how staff were resolving the problem. Staff spoken to said that because there was a lot of information in the plans that needed updating continually they felt a lot of their time was spent doing this rather than providing ‘hands on care’. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 10 The way in which peoples medication is looked after by the home has been an area of concern, and the home are working with the Primary Care Trust to resolve some issues. A lot of work has been undertaken at the home to make sure that people get their prescribed medication properly. During this inspection we found that when people are out with family or friends for the day, their medication is omitted and signed for as not given. When staff where asked about this they said it was normal practice not to give people their tablets to take with them, as often they did not know when people had left the home. The manager needs to review this. We also found that one person had tubes of cream left in the en suite bathroom that should have been locked away. In addition on checking the medication administration record this person had not been prescribed these creams. The treatment rooms on the lower and middle floor were very hot and above the temperature for storing some medication. The management at the home were aware of this and have ordered air conditioning units for these rooms. From observation some peoples privacy and dignity was not always protected by staff. Some examples of this were, people sat in lounge chairs or else in their bedroom still wearing clothes protectors, a couple of hours after lunch, some people still had dried food around their mouths. Some people had not had their hair brushed and others had dirty nails and chipped nail varnish. One person was sat in a chair stained with faeces. Another person was being barrier nursed; we knew this because of the large sign on the bedroom door and the table outside the door with hand rub, aprons and gloves on it. Some people’s fluid balance charts and food records were left in the communal dining rooms for everyone to read. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good In most cases the recreational and social needs of people are catered for which enables people to make daily choices and promote independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activities organiser on a part time basis, who has only been in post a short time. She explained that she was getting to know everyone and what they enjoyed doing before she set up any structured activities. Around the home there was jigsaws set up and boxes of old photographs for people to look at, however some people said they were bored looking at the same photographs and would like more things to do. The people who live in the dementia units have very little organised activities most sat in the lounge areas unsupervised. One person was sat alone in the dining area ripping paper serviettes. People in the nursing and residential unit had a different experience. One person said’ there is lots to do, I manage to get out when the weather is fine’. Another person said ‘ I like the quiz and bingo, I am never bored’. Another person was being assisted by a member of staff to get some shopping in town. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 12 Everyone said the food was lovely the chief was knowledgeable about peoples diet requirements. It was evident that he had a good relationship with the people at the home, people told us he regularly checked if they were enjoying the meals and always tried to alter the menus cater for everyone’s taste. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 Quality in this outcome area is good. People can be confidant that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are adequate written policies and procedures in place to deal with complaints and the care staff spoken to confirm they were aware of these. Staff knowledge of these help ensure that they were able to address any issues or anxieties of the residents, relatives and visitors to the home. People who live at the home told me they would speak to the manager or any of the staff if they had any concerns or complaints. Staff told me that training has taken place in the protection of vulnerable adults in abuse. I looked at four personnel files and found that staff recruitment procedures were adequate and staff were employed and deployed following appropriate checks. The manager and staff team were clear and confident in the protection of vulnerable adult procedures. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. People live in a safe, comfortable, and homely environment. This judgement has been made using available evidence including a visit to this service EVIDENCE: During the inspection new carpets were being laid throughout the corridors and dining areas of the home. New curtains and soft furnishings were also being replaced. People’s bedrooms were clean and tidy. Some bedrooms needed the flooring replacing this was identified at the previous inspection, and this was also being done. One bathroom was being refurbished and several at the time of inspection were out of order. Leaving only one bathroom on each floor in use. The home was aware of this and was trying hard to get the bathrooms back in working order as soon as possible. Staff have had training in controlling infections. The laundry was organised and people’s clothes looked clean and well pressed. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 15 Staff have now received fire training in accordance with the fire and rescue services. There were no outstanding requirements from the fire and rescue service inspections or from environmental health inspections. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29,30 Quality in this outcome area is adequate Whilst the recruitment and training of staff is good, staff are not deployed properly and some peoples need were not being met fully. This judgement has been made using available evidence including a visit to this service EVIDENCE: The rotas and staff numbers suggest that there are enough staff on duty at all times to meet the needs of the people who live at the home. However people in the dementia unit were left for long periods without any supervision. We sat in the lounge area of the unit; sometimes people were left for up to thirty five minutes before a member of staff entered the lounge. Some people were agitated during this time as they could hear staff talking and laughing in the corridor outside the lounge. The way staff are deployed on this unit needs to be reviewed. Ten staff returned completed surveys to us, most said that staff morale was low and felt there was not enough staff on duty at busy times during the day. We asked staff what the service could do better? One person wrote, ’Improve communications. Show respect for staff. (wages) the way we are spoken to. Provide correct provisions ASAP rather than months later (new bath) and (fixing baths). Provide more sensory equipment. Provide money to do events such as xmas/easter.’ Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 17 I looked at a selection of staff files. They all included completed application forms and two written references. The files showed that satisfactory Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks have been obtained. I was assured that no new member of staff starts work until a POVA register check had been completed. Then, if the CRB check had not been received, they would work only under the supervision of an experienced staff member. Staff are given the necessary training to help them do their work as well as possible. There is a wide range of courses available and the records confirmed that the staff are allowed the time to attend. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate People would be better protected if the home had a registered manager who was accountable for their health, well being and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manger of the home has recently resigned; the area manger and the operational manger are sharing the responsibility at the home until another manger is appointed. The home has a quality assurance system, and the company have a good audit system. The area manager carries out a quality assurance and monitoring visit on a monthly basis. A report from these visits is held at the home, and covers all aspects of care delivery and environmental issues. Despite issues identified during these monthly audits, in some instances there was no evidence to suggest that action had been taken to rectify any shortfalls by the previous manger. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 19 I looked at the records held at the home regarding people’s personal allowance. All transactions are recorded correctly and receipts are kept. One person’s money was counted and matched the total on the record. Policies and procedures are kept up to date; to make sure they provide relevant information to guide staff on how to act in every situation. All the regular health and safety checks for the home are carried out in a timely manner. I looked at some certificates to make sure that equipment was safe and had been maintained. All these measures make sure that the health, safety and welfare of the people who live at the home is promoted and safeguarded. Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 3 Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement All medication must be stored at the correct temperature, as directed by the manufactures instructions. Previous time scale not met To avoid the risk of harm people must only be administered medication that has been prescribed for them. Staff need further training in maintaining peoples privacy and dignity Meaningful Activities that are suitable and relevant to peoples requirements must be provided. To ensure that people receive the care and support they need, staff must be employed an deployed properly. To ensure that the care home is managed properly the provider needs to recruit a suitable person to become registered manager of the home. Timescale for action 31/05/08 2 OP9 13 17/01/08 3 OP10 12 &18 31/05/08 4 OP12 16 31/05/08 5 OP27 18 17/01/08 6 OP31 12 31/05/08 Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sandringham Care Home with Nursing DS0000063946.V358150.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!